Provider Demographics
NPI:1942637509
Name:SIMON, ANDREW JOHAN (ND)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOHAN
Last Name:SIMON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 LEARY AVE NW STE 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4070
Mailing Address - Country:US
Mailing Address - Phone:360-430-9767
Mailing Address - Fax:
Practice Address - Street 1:5401 LEARY AVE NW STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:206-297-6013
Practice Address - Fax:206-582-3472
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60412804175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035017Medicaid